An estimated 5.4 million Americans are currently suffering from Alzheimer's disease (AD), and AD cases are expected to rise at an alarming rate, so market potential exists for products, approaches, and/or training that can help treat and/or circumvent the challenging behaviors associated with the condition. One approach that has been shown to be effective involves the use of Montessori Activity Programming (MAP). This study will involve the further development and refinement an innovative MAP activity called the Hearthside Book ClubTM (HBC), which will be the first-ever dementia-level appropriate reading materials. For each of 32 topics, four different versions of a story/essay will be created. Developed for persons in the early stages of dementia, A- Grade Level Reading Materials will be 30 pages in length and be written at an 9th grade level; AA-Grade Level Reading Materials, developed for persons in the Middle Stages of dementia, will be 25 pages in length and will be written at the 6th grade level; AAA-Grade Level Stories, created for persons in the Late Stages of Dementia, will be 20 pages in length, and will be written at the 4th grade level; finally, AAAA Grade Level Stories, created for persons in the Very Late Stages of Dementia, will be 15 pages in length, and be written at the 3rd grade level. So, a total of 128 stories will be created for ths study. Half of the stories will contain pictures. A total of 120 older adults with dementia will participate in the study. They will be assigned to one of four groups: the Early Stage Group (Mini-Mental Status Exam (MMSE) score of 18+), the Middle Stage Group (MMSE, 11-17), the Late Stage Group (MMSE, 5-10), or the Very Late Stage Group (MMSE<5). The engagement of persons taking part in HBC sessions will be compared against their engagement in standard, baseline activities. Engagement during HBC sessions will also be compared against engagement in Reading Roundtable(R) (RR) sessions. RR stories are designed for persons with dementia, but are not adjusted for varying levels of dementia. Key proximal outcome measures include engagement and communication patterns; key distal outcome measures include quality of life, depression, and agitation. Distal measures will be taken at baseline, afte one month of RR sessions, after one month of HBC sessions without pictures, and after one month of HBC sessions with pictures. The Specific Aims of the study are: (1) to develop improved HBC stories based upon lessons learned in Phase 1; (2) to develop a enough number of HBC stories for two months of activity programming; (3) to develop HBC stories for persons with severely advanced dementia (MMSE<5); (4) to implement reading groups at three types of facilities (nursing homes, assisted living facilities, and adult day centers); (5) to examine the proximal and distal effects of the reading groups; (6) to examine the effects of the reading groups on communication patterns of persons with dementia; (7) to examine whether the effects of the intervention varies among the three levels of care; and (8) to use results of the Phase 2 study to create a final, market-ready version of the product. PUBLIC HEALTH RELEVANCE: An estimated 5.4 million Americans are currently suffering from Alzheimer's disease (AD), and AD cases are expected to rise at an alarming rate. Besides affecting the person with the condition, AD also presents a public health concern, due to the significant cost required to care for persons with dementia and due to the mental and physical stress placed upon caregivers of persons with dementia; so, there is an urgent need for products and programs that will engage and stimulate persons with dementia, while at the same time reducing the stress on caregivers. Through the development of special reading materials for persons of varying levels of dementia, the proposed project will help meet this need.